Health jobs, Uber, and Medtronic hunts for value

Happy Sunday!

A few items from the world of healthcare this week…

Health care has become the country’s largest employer for the first time in history. Nisarg Patel wrote a superlative article on the subject of job growth in health care this week in STAT.

If you dive into the Bureau of Labor Statistics Occupational Outlook Handbook, you’ll see healthcare is well represented on their three main lists: highest paying occupations, fastest growing occupations, and most new jobs. Of the top 10 highest paying occupations, 6 are MD’s (the other four are oral surgeons, orthodontists, psychiatrists, and then CEOs).

What’s interesting is that the most new jobs are expected, far and way, to be physician extenders.The top 10 occupations with the most new jobs include personal health aides, registered nurses, home health aides, medical assistants, and nursing assistants. These people do much of the heavy lifting in healthcare that occurs outside of the exam room. One of the major pushes in healthcare right now is for improved management of chronic conditions like diabetes and COPD, and that burden falls mostly on these physician extenders.

These are also the jobs that digital health companies are looking to disrupt out of existence. If technology is properly applied to healthcare, it will be as an amplifier of ability rather than a replacement for physicians. The goal should be to preclude the need for an army of health aides by enabling a physician and her staff to more effectively meet the inter-visit needs of a population through the use of messaging, monitoring, and automation. Essentially, if healthcare tech companies achieve their lofty goals, this BLS report will be proven wrong.

Uber announced this week they’ll fully launch the medical transportation service they’ve been testing. While this service taps into the same Uber cars you can order yourself, it allows medical offices to essentially dispatch Uber cars to their patients to carry them to their appointments.

Uber is pitching this service as a way for medical offices to lower the number of missed appointments from patients who claim transportation issues as they reason they didn’t show up. Missed appointments are a bigger problem for healthcare practices than one might realize: estimates put the share of missed appointments at around 20 - 30%. If a practice has 40 appointments scheduled in a day, that’s 12 patients who won’t be coming, and 12 visits for which the office won’t be able to bill health plans.

Practices have dealt with this issue in different ways. They’ll call patients to remind them of upcoming appointments, send cards in the mail, and even levy fees for missed appointments. On the planning side, many practices will simply book 20% more appointments than they actually have room for in the schedule, expecting many of those to be missed. This is often the reason waiting rooms are full of patients who arrived on time and yet still have to wait.

While unreliable transportation must be responsible for a share of these missed appointments, I wonder how much of that is just patients reporting it as a convenient excuse; one that’s a little less embarrassing than “I forgot” or “I didn’t feel like going to the doctor.”

From Uber’s perspective, this could be a way to tap into a broader customer base. As the medical office is dispatching the car, and paying for the car, patients who don’t have Uber accounts will now be using the service. I’d imagine this will lead to some new account sign ups, and those will likely be from people who fall outside of Uber’s typical younger and more digitally-aware customer set.

It’s too soon to guess how productive this service will actually be. Medical offices have always been able to call a cab for patients, so aside from the ease of scheduling through Uber’s health portal there’s not much innovation here. In my view, the weakest point is the front-desk staff, who are already asked to do a wide variety of administrative tasks, and will now be taxi dispatchers as well. I doubt they’ll see an increase in pay to match their added responsibilities.

Medtronic, continuing their push towards value-based care* that I discussed in last week’s post, has inked a deal with Lehigh Valley Health Network to work collaboratively to develop value-based payment models for many of Medtronic’s devices.

Medtronic wants more contracts with hospitals that let hospitals pay them only if their devices actually contribute to a positive outcome. The limiting step is the ability to ensure that providers are using these devices in a way that Medtronic believes will actually lead to good patient outcomes.

While it wasn’t spelled out in their press release, I’d suspect that Medtronic and Lehigh Valley will develop protocols for treatment using Medtronic devices. In the future, Medtronic will allow providers who follow their protocols to pay them on a value-created basis, while providers who use their devices in a way that deviates from the protocols won’t be eligible.

Overall, it shows that Medtronic is committed to venturing into value-based care. Being an early mover in this space, and working with a large provider network like Lehigh to create protocols and success metrics could be a real boon to Medtronic in a system that is moving closer to value-based payments all the time.


That’s all for today. Thanks for reading, and remember, sharing is caring!