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Most Outpatient Practices Have Adapted to The New Normal—But Not Pediatrics

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Most Outpatient Practices Have Adapted to The New Normal—But Not Pediatrics

Data from The Commonwealth Fund offers a glimmer of hope as it suggests outpatient care has finally rebounded during the pandemic. As a matter of fact, weekly visits to certain specialists, such as rheumatologists and oncologists, exceeded the pre-pandemic baseline.

Pediatrics seem to be the exception to this—by far. In December 2020, there were 24% fewer pediatric visits (whether telehealth or in-person) compared to December 2019, making it the worst-hit outpatient specialty right now.

The American Academy of Pediatrics is specifically trying to push for more wellness visits.

Why are parents foregoing wellness visits?

I’m interested to know the top 3 reasons why kids aren’t coming in for visits. I’m eagerly waiting to hear back from the researchers of Commonwealth Fund study with the answer.

In the meantime, here are possible reasons:

  • The Institute for Child Success suggests that this declining trend may be due to the overall trend of slow increase in Medicaid patients returning for doctor visits. According to Kaiser Family Foundation, 37.5% of pediatric population was covered by Medicaid in 2019. I imagine that this number is much larger right now. 
  • The Institute for Child Success also points out that there has been a rise in child abuse/trauma during the pandemic.
  • Record number of mothers are leaving the workforce due to burnout.
  • The Primary Care Collaborative suggests that practices that weren’t able to weather the pandemic were shut down.

At the professional level, it’s hard for market access strategists to act on this problem without knowing its largest contributors.

At a human level, however, there is something each of us can do. There’s no question that this pandemic has been hard on all of us. We all could benefit from seeing others and being seen. It’s called Sawubona.

Try to catch someone doing something right–then call them out on it. Do this 3 times everyday for the next 1 month. Notice what happens to your conversations. Notice what happens to you.

Whereas blaming undoes us, the posture of good-finding nourishes us. Try it.

Who Is This Really For?

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Who Is This Really For?

On the same day, both Harvard Business Review and Adam Fein exposed the reality of consolidation within the health care system.

Harvard Business Review predicts that the pandemic will speed up this process. “Given the financial difficulty that many providers have suffered during the pandemic, this trend is likely to continue, reducing competition and increasing prices.”

It seems like the big players are riding the wave (for now, at least).

What I’m wondering is: is this the ultimate truth (big guys get to have all the fun), or is this the perfect opportunity for a new guy (not necessarily little—just new) to creep in and make it reign?

Scott Galloway points out that our health care industry is the industry with the lowest net promoter score (basically, it’s a broken system—as if we needed someone to tell us this). Therefore, the health care industry is ripe for incumbents to be replaced by newcomers.

Generally speaking, smaller companies are more nimble than larger companies. Will the sheer size of a large conglomeration inhibit itself to react/adjust to the borderline-prophetic Great Dispersion as suggested by Scott Galloway? This could very well be the perfect opportunity for a newcomer who wants to eat the pie (not just a slice…but all of it).

To put all of this in a different way, here are 2 questions: (1) Who is this [the vertical and horizontal integrations] for? (2) Who will this be for? Hint: many people have the answer to the first question; the second question cannot be Googled.

To put all of this in a 3rd way: Seth Godin says, ’empathy is at the heart of design.’

Catch the Raindrops Before They Become Hurricanes

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Health care is in for flipping its thinking from defensive to offensive, according to Scott Galloway. He cites CDC data suggesting that 90% of health care spending is linked to chronic and mental health conditions. A widely cited Health Affairs article suggests that only 8% of the population takes advantage of preventative care. ‘Instead of detecting diseases when they’re raindrops, we wait until they become hurricanes that flood and overrun the health care system.’

Let’s not point fingers, because we are all to blame at some level (patients, providers, payers, manufacturers, me—all of us).

It’s hard to let go of our old ways, but sometimes that’s the only choice. The more something doesn’t work, the more we want to hold on to the fantasy that it does.

Flipping our thinking from defensive to offensive, by catching diseases in their early stages, American health care can be more efficient and effective.

I love the way Rohan Rajiv states, ‘walking a mile in another person’s shoes is powerful. Perspective makes us humans.’

What can we let go? What can we pick up?

What can we do to help switch from a defensive to offensive strategy?

Curiosity is like a flashlight

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Imagine you’re on a camping trip and you’re hiking back to your tent in the pitch dark. You have little more than a flashlight to guide the way. You cannot see the tent from where you are because the flashlight is only able to reveal what’s 20 feet beyond you. Even then, you have faith that if you continue walking, the flashlight will continue to light up the next 20 feet until you finally reach your destination.

In market access, curiosity is like that flashlight. Having curiosity has helped me uncover so much knowledge. In fact, I’m learning new things all the time when I charge ahead with curiosity in my hand. 

Curiosity brings knowledge, which makes one valuable in market access.

Charlie Munger, considered to be Warren Buffett’s right hand man, is famously quoted for saying, “Go to bed smarter than when you woke up.”

Seth Godin, a renowned author and entrepreneur, says that he spends 16 hours per day learning, reading, or doing research.

Ask questions, watch, listen…you’ll be surprised at what you’ve been missing.

It’s time to make big strides and turn heads–let’s go.

Market access needs courageous innovators to break the mold

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Two hundred forty three years ago, on July 4, a small startup decided to declare itself as a separate entity from its successful parent company that was then considered the wealthiest in the world. In a matter of a few short years, the large parent company was declining, while the startup has ascended to be considered the most powerful in the world. Small startup = United States; large parent company = Great Britain.

History is our biggest teacher, and the US independence teaches us that no matter how small or how large, the most courageous player gets the cake.

“Innovation” doesn’t happen with the wave of a wand by an Innovation Wizard. Innovation is brought about by real people all around us. Perhaps you’re sitting next to an innovator right now–or perhaps YOU yourself are an innovator–or perhaps the author of this blog is an innovator.

Innovators are courageous. They challenge the status quo, take risks, and accept failure as a natural process for innovation (IDEO’s risk-taking philosophy is “fail soon to succeed sooner”).

You still can’t think of a courageous innovator that you know? Let me help you out by giving you a few examples of courageous innovators that I know (fictitious names, but real incidents):

Nancy-the-rookie who performed a job worth millions, or more​

Nancy’s company lost a valuable client because her team produced a billable project that was ridden with errors. Nancy took it upon herself to conduct a Root Cause Analysis and spent approximately 40 hours of her own time interviewing team members and drafting a report, in which she concluded that her company could benefit from a more organized workflow in order to prevent such incidents in the future.

Nancy’s Root Cause Analysis report sparked changes at her company.

Fast-forward 2 years –> Nancy’s company has established swim lanes for all team members. Now, her company is able to produce excellent projects on predictable budgets, while keeping employees happy because the need to work nights and weekends has basically been eliminated due to the great efficiency.

Tyler-the-writer who delivered a presentation at a HUGE and FAMOUS national conference

Tyler, though operating under the title of a Medical Writer, is always looking for opportunities to establish himself as a thought leader. He stumbled upon an ad from a HUGE and FAMOUS national conference which was calling for speakers. Tyler decided, “why not?” He got permission from his manager, and her manager as well. Despite many, many, MANY obstacles, Tyler was accepted to speak at the HUGE and FAMOUS national conference. Not only that, Tyler and his co-speakers delivered such a ROCKING presentation, that it was chosen to be one of the online enduring presentations on the conference website.

Look around you for courageous innovators, read articles and books to become courageous yourself, and network to get fresh ideas.

If you are under pressure to deliver results and protect your margins, you should DEFINITELY be seeking out these courageous innovators, as they are the ones who bring in the trophies.

It’s time to make big strides and turn heads–let’s go.

Krishna Patel, PharmD
Market Access Strategy and Execution Consultant
info@sojusllc.com
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