The Goal is Infinite

I assume/hope that our customers in the On Site Clinics project are as happy as we are, but doing a good job is not the optimal thing. The legendary golfer Bobby Jones had a great second shot on a par 4 hole. The ball landed 2 feet from the hole, great birdie of course. A spectator shouted “great shot Mr. Jones”. Bobby looked at him and said “every golf shot can be better except the last one”.

Celebrating success is nice and okay, maintaining and repeating success is also good, but doing better is more thrilling and satisfying. I know that the standard SOP of businesses is to tell their clients how well they are serving them; to me that is mediocrity. We always aspire to explore ways and means of doing better – that is the subject of this article.

The daily/weekly watch and analysis of the operations at the Onsite Clinics is my guide on how we can do better and what things we can do together to make the project increasingly successful. One of the observations I have made repeatedly is the exuberant use of brand name drugs when a generic like or same class of drug is available in the market. Of course EHCS providers are doing what they are supposed to do, but we are failing when the brand name drug is prescribed by primary care providers outside of the onsite clinic. It has become obvious that changing the prescription from brand name to a generic alternative is a challenge based on perception and often pushed from the outside primary care provider to dispense as prescribed.

In one of my favorite books, Freakonomics, the authors with remarkable eloquence and scientific evidence demonstrate that the only thing that changes human behavior is money. The author’s conclusions in the book are revolutionary compared to what Sigmund Freud theorized. The question is : how do we use the $$$ to make our model better? There are two ways, not either but both:

  1. Undoubtedly many patients want to maintain their relationship with their historic primary care provider for many reasons; that is all good and fine. I like my cigars and love my bourbon, but I pay for them. In fact I can’t even take a tax deduction for what I enjoy. Many patients wrongly think that two brains are better than one, - that is to say having two primary care providers is better than one. Again one of my favorite books is Crowd, written at the end of the 19th century by Gustave LeBon. LeBon concludes that the collective intellectual power of a group is lower than that on any individual in the group. Basically a decision made by an individual is almost always better than that made by a committee. His conclusion is proven out in modern psychological research looking at group versus individual performance – knowledgeable individuals regularly outperform groups working on the same problem. (Hall, J. (1971), Psychology Today, November 1971.)

    My conclusion on this is: if a patient really wants to defy science and logic, they should have a significant financial responsibility for the choice they make. Allow them to choose a brand name medication – on the condition that they bear the economic cost of that choice.

  2. A different but related item to point number 1 is the issue of brand name versus generic. The Pascal Wager was a philosophy by Pascal, a 17th century philosopher who tackled the subject of faith. Pascal said that if your wager has a one in a million chance to succeed and if it doesn’t succeed you have nothing to lose, then you should take that non-existent chance. He was referring to the fact that if you believe in God even if there is a one in million chance that God does exist, do it, because you have nothing to lose if you believe, but if you don’t believe and there is God ten you are screwed eternally.

If a patient has a one in a million suspicion that a brand name medication is superior to an alternative generic drug, and if he or she has nothing to lose by choosing the brand name, why take that one in a million chance? But if choosing a brand name has substantial financial implications, a second thought and action would be worthwhile.

I hope this helps our customers in the future design of the health benefits for their valued employees. I am convinced with no doubt that any action and policy that we propose not only cuts costs, but they actually provide better accessible medical care. After all, Good Medicine is Cheaper Medicine.

Kelsey Knutty