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Perspectives

Will Investors Help or Harm Our Field?

November 23, 2020

Our industry needs financial investment to thrive. Too many of our programs are small and struggling. Private investors have focused on our industry for several years. This is driven by many things, but a big one is the increase in insurance funding for our industry due to parity legislation. We should be wary. Interests are never aligned exactly between those giving and receiving money.

Investors do not select opportunities in a haphazard way. They find promising segments. In our industry this has meant specialty programs like those for substance use disorders and autism, as well as start-ups in digital healthcare. Investors do not run businesses. They want to make money by funding gems that will increase in value. Will the success of those programs benefit the entire field?

The aphorism “a rising tide lifts all boats” means that a growing economy helps all participants do better. This may be true for our field to some extent. However, the inverse of this phrase seems more likely. Rising boats will not lift the tide. Those boats, or programs, that rise due to private financing will not lift the overall wealth of the field. It may even hurt the field over time.

My point of reference for this argument is the practice of medicine outside of our field. We have long witnessed higher funding by government, insurance and private sources for specialty care compared to primary care. Doctors learn early that they will make more money by specializing in procedures than working in primary care. The PCP role emphasizes thoughtful assessment over technical expertise.

This trend is expanding and manifesting itself in new ways. We have seen pharmacy corporations place clinical pods with nurse practitioners in their stores. They write prescriptions for common conditions and administer vaccines. A similar development is currently under discussion involving pediatrics. New clinical pods might begin to provide immunizations for infants and children.

If these clinicians can safely provide these services, what is the problem? Nurse practitioners will never provide the clinical assessments that pediatricians trained for years to learn. Pediatricians would be free to continue providing developmental assessments. Yet many parents will skip these visits if all seems well. Carving out immunizations could have a long-term, negative impact on pediatricians.

Our field may encounter similar issues. Certain specialized services (e.g., detox) might initially emerge as ripe for investment, to be followed by clinical activities being split off to be commoditized (e.g., digital therapeutic modules) or delivered by lower cost providers (non-professional coaches). This process has been detrimental for PCPs and could be for our clinicians. It is being raised only as a trend to watch.

It would be wrong to demonize the investment process. It will be swept up by larger trends. We can shape it to the ends we choose. As to the question posed in this article’s title, investors will do neither. The field is ours to mold. We need a good investment strategy. We should collaborate with investors and innovators. What is that strategy? Strangely enough, my idea is to move into primary care.

We should join primary care to reinvent it and to transform our field. Together we can create a more comprehensive and effective frontline service. There is a good future in this. Investors can make good returns, clinicians can prosper and patients will find an environment more conducive to better outcomes. Let us avoid a future where the winners chase new procedures and subspecialties, with general practice relegated to second class work.

Our investment value is greater in primary care. We not only provide effective solutions for people with mental and substance use disorders, but we reduce the suffering of millions with subclinical conditions. Yet the unhealthy behaviors driving chronic medical conditions represent our biggest opportunity. Our professionals have a solution that needs investment funding to be taken seriously.  

PCPs need people to change unhealthy behaviors and stick with recommended treatments. Such behavior change requires therapy, not friendly advice. Therapy needs modification for this purpose, and this is feasible. It will be a monumental day in healthcare when we offer evidence of such behavior change. More than a pilot study is needed. We must prove this on a large scale, or it will be ignored.

I may be engaging in wishful thinking but change often begins there. We need to fund centers of excellence to demonstrate this new primary care model. There are precedents. New York State offers an example with its NYSTAR programs. They fund centers of excellence that bring together innovators from business, academia and government. They solve big problems and leverage all available talent.

The goal here is not to provide the realistic contours of such a plan, but the need for a long-term vision. Investors have a role, but so do leaders in our field. Executives must envision the industry we want. The recent death Nick Cummings, who transformed education and management in our field, should remind us of that bold thinking. He was not always right, but he was never afraid to dream.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.

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