By Ali Khan, M.D., Tasce Bongiovanni, M.D., and Ali Ansary
Let's get the disclaimer out of the way: We love Uber.
As physicians with roots in the Bay Area, we use Uber all the time. The service is convenient, (usually) swift and consistently pleasant. With a few taps of a smartphone, we know where and when we'll be picked up -- and we can see the Uber driver coming to get us in real time. When the vagaries of San Francisco public transit don't accommodate our varying schedules, it's Uber that's the most reliable form of transportation. (It might be that we like having some immediate gratification.)
So when we caught wind of the news that Uber's founding architect, Oscar Salazar, has taken on the challenge of applying the "Uber way" to health care delivery, there was quite a bit to immediately like. From our collective vantage point, Uber's appeal is obvious. When you're feeling sick, you want convenience and immediacy in your care -- two things Uber has perfected.
And who wouldn't be excited by the idea of keeping patients out of overcrowded emergency rooms and urgent care waiting rooms? The concept of returning those patients to their homes (where they can then be evaluated and receive basic care) seems so simple that it's brilliant.
Even better, in an era where health care costs are on the minds of many, Uber's financial structure offers the promise of true price transparency for consumers -- a rarity in current American health care. Imagine a system in which, from day one, patients understand how much their care will cost them. That's the kind of disruptive innovation for which there's already considerable market demand (as evidenced by the other players in this space); its potential to effect a sea change in health care delivery is even greater.
As physicians deeply immersed in the health policy and innovation arenas, we naturally "get it." So, then, are we cheering for Uber Health?
Hardly.
Lest you lump us in with Jessica Seinfeld, however, allow us to explain ourselves.
Our concern rests on the potential negative externalities that a disruption like Uber, previously validated in a rational market, can generate when introduced to an irrational one, like health care.
In American medicine these days, many of us are hard at work trying to bend the proverbial cost curve. Considerable research suggests that we can generate significant savings through early, aggressive management of medical problems in the primary care setting -- before they lead to the emergency room visits, disease progression, inpatient hospitalizations and subsequent complications that cost billions.
The "Uber way" might tackle part of that challenge, through the avoidance of those expensive ER visits (and, by extension, potential hospitalizations). By encouraging one-off visits from physicians at home, however, that model ignores the longitudinal primary care component that enables the execution of that prevention strategy. In doing so, it fails to capture a critical aspect of the existing value proposition in health care delivery. Most people, after all, wont' be calling Uber for an elevated cholesterol level or a screening colonoscopy.
For what it's worth, other actors in the health innovation arena understand the necessity of that longitudinal component. The blossoming concierge medicine industry offers a primary care home with exclusivity. Meanwhile, health care startups such as Iora Health (where one of us works) and One Medical Group promise radically re-envisioned primary care clinics as a critical element of the next social transformation of American medicine. Still others, such as Sherpaa and the health insurance startup Oscar, coordinate services similar to the Uber home visits but within the context of insurance coverage, embedding those visits into a comprehensive model of integrated primary and secondary care.
Technological innovation, at face value, is an incredible tool for social change. Many of the nation's hottest startups often make a moral (or "solutionist") argument for their work. At times, the products they offer can appear more like innovation for innovation's sake -- technology that is created for no obvious social purpose. But we choose to consider an alternative argument.
We posit that technology has vast potential as a social good -- potential that as of yet remains unrealized. The "Uber way," if considered carefully with a robust medical "home" (be it the patient-centered medical home or otherwise) at its center, could produce positive externalities that impact the lives of millions. Without that core, however, the Uber model runs the risk of becoming yet another example of innovation forged in a vacuum, providing health care on demand -- and ignoring the need to contextualize that care within the longitudinal narrative of one's overall health. We thus offer a path to mitigate that risk for "Uber Health's" future customers -- and that's a solution for which we'd be willing to wait.
And let's not even get started on surge pricing during flu season.
Ali Khan, MD, MPP is an internist at Yale-New Haven Hospital and a clinician-innovator at Iora Health. He currently serves as the chair-elect of the American College of Physicians' National Council of Resident/Fellow Members. Tasce Bongiovanni, MD, MPP is a Robert Wood Johnson Foundation Clinical Scholar at Yale University and a surgical resident at the University of California, San Francisco. Ali Ansary is the founder of SeventyK.org and a senior medical student at Rocky Vista University.