MMHA 6601 Week 2 Disruptive Innovation Post Example

Week 2 Discussion: Initial Post and Replies

Virtual Urgent Care Is Disruptive for Patients but Sustaining for Most Health Systems

Christensen's idea of disruptive innovation describes a simpler, cheaper offering that starts by serving customers the incumbents ignore or overserve, then improves until it takes over the mainstream market. Applied to health care, the theory predicts that disruption comes through new business models that let less expensive providers handle problems once reserved for costlier ones (Hwang & Christensen, 2008). I want to argue that direct-to-consumer virtual urgent care fits that description from the patient's side but, for most health systems, has turned out to be a sustaining innovation rather than a disruptive one.

From the patient's side, the fit is strong. A video visit for a sinus infection or a urinary symptom is simpler and more convenient than a trip to an urgent care center or a primary care office, and it serves people who might otherwise have done nothing, such as working parents who could not leave their jobs. That is the classic pattern: a good-enough product for a less demanding need, delivered more conveniently. Good enough is the right phrase, because a study of direct-to-consumer telemedicine companies found wide variation in how well virtual clinicians followed guidelines for common conditions (Uscher-Pines et al., 2016), which is what early disruptive products usually look like before they improve.

For the cost side, the evidence is less kind to the disruption story. A study of a large commercial population found that direct-to-consumer telehealth visits increased overall use and spending for acute respiratory illness, because most virtual visits were new use rather than replacements for in-person visits (Ashwood et al., 2017). Disruption is supposed to lower total cost by moving care down-market; here, it added a new layer.

The bigger reason I see it as sustaining, though, is who now offers it. Many health systems, including the composite network I use in this course, run their own virtual urgent care services staffed by their own clinicians. They added video visits to existing practices to keep patients from going elsewhere. Christensen's theory says incumbents struggle to adopt disruptive innovations because the new model does not fit their profit formula. When incumbents adopt something readily and fold it into existing services, it is usually sustaining.

Where disruption may still be happening is in independent virtual-first primary care companies that build their whole model around video and messaging, with physical visits only when needed. Those firms are trying to change the business model, not just add a channel.

Question for the class: in your organization, is virtual care replacing in-person visits or adding to them, and how would you tell?

Reply to Maria

Maria, your point that your hospital's telehealth program reduced emergency department visits for low-acuity complaints is a useful counterweight to my cost argument. Whether that happened depends on what patients would have done otherwise. Ashwood and colleagues found that only a small share of virtual visits replaced in-person ones in the population they studied, but your program targeted patients already headed to the emergency department, which is a different group. If your program can show that the people using it had a history of emergency visits for similar complaints, that would strengthen the case that it substituted rather than added. Do you know whether your hospital tracked where users had gone for care in the year before?

Reply to Darnell

Darnell, I agree that retail clinics were an earlier disruptive wave in the same space, and they make a helpful comparison. Retail clinics also promised to replace costlier visits, and studies found that much of their use was new rather than substitutive, which is the same pattern I described for virtual care. One difference is that retail clinics changed who delivers care, nurse practitioners in pharmacies, while most virtual urgent care keeps the same clinicians and changes only the channel. Under Hwang and Christensen's framing, a change in who delivers care at lower cost is closer to a true business model shift. Do you think virtual care will eventually do the same, with more care delivered by lower-cost clinicians at a distance?

References

Ashwood, J. S., Mehrotra, A., Cowling, D., & Uscher-Pines, L. (2017). Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Affairs, 36(3), 485-491. https://doi.org/10.1377/hlthaff.2016.1130

Hwang, J., & Christensen, C. M. (2008). Disruptive innovation in health care delivery: A framework for business-model innovation. Health Affairs, 27(5), 1329-1335. https://doi.org/10.1377/hlthaff.27.5.1329

Uscher-Pines, L., Mulcahy, A., Cowling, D., Hunter, G., Burns, R., & Mehrotra, A. (2016). Access and quality of care in direct-to-consumer telemedicine. Telemedicine and e-Health, 22(4), 282-287. https://doi.org/10.1089/tmj.2015.0079